Chapter 107
Tactical emergency medical support
David K. Tan,
Jeffrey E. Siegler,
David K. Tan
Search for more papers by this authorJeffrey E. Siegler
Search for more papers by this authorDavid K. Tan,
Jeffrey E. Siegler,
David K. Tan
Search for more papers by this authorJeffrey E. Siegler
Search for more papers by this authorBook Editor(s):David C. Cone MD,
Jane H. Brice MD, MPH,
Theodore R. Delbridge MD, MPH,
J. Brent Myers MD, MPH,
David C. Cone MD
Professor of Emergency Medicine
Yale University School of Medicine, New Haven, Connecticut
Search for more papers by this authorJane H. Brice MD, MPH
Professor of Emergency Medicine
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Search for more papers by this authorTheodore R. Delbridge MD, MPH
Executive Director
Maryland Institute for Emergency Medical Services Systems, Baltimore, Maryland
Search for more papers by this authorJ. Brent Myers MD, MPH
Chief Medical Officer ESO Associate Medical Director
Wake County EMS, Raleigh, North Carolina
Search for more papers by this authorFirst published: 18 August 2021
Summary
Although beginning as medical support to SWAT teams, tactical emergency medical support (TEMS) now encompasses the provision of preventive, urgent, and emergent medical care during high-risk, extended-duration, and mission-driven law enforcement special operations. Recognizing the benefit of medical support in these volatile situations, the National Association of EMS Physicians endorsed the concept of integrating EMS capability into law enforcement special operations in 2001, and TEMS remains a dynamic and evolving discipline within EMS medicine.
References
- U.S. Department of Justice, Federal Bureau of Investigation . Uniform Crime Report, Law Enforcement Officers Killed and Assaulted, 2019 . Washington, D.C .: Government Printing Office , 2020 .
- U.S. Department of Justice, Federal Bureau of Investigation . Uniform Crime Report, Law Enforcement Officers Killed and Assaulted, 2014 . Washington, D.C .: Government Printing Office , 2015 .
- U.S. Department of Justice, Federal Bureau of Investigation . Uniform Crime Report, Law Enforcement Officers Killed and Assaulted, 2015 . Washington, D.C .: Government Printing Office , 2016 .
- U.S. Department of Justice, Federal Bureau of Investigation . Uniform Crime Report, Law Enforcement Officers Killed and Assaulted, 2016 . Washington, D.C .: Government Printing Office , 2017 .
- U.S. Department of Justice, Federal Bureau of Investigation . Uniform Crime Report, Law Enforcement Officers Killed and Assaulted, 2017 . Washington, D.C .: Government Printing Office , 2018 .
- U.S. Department of Justice, Federal Bureau of Investigation . Uniform Crime Report, Law Enforcement Officers Killed and Assaulted, 2018 . Washington, D.C .: Government Printing Office , 2019 .
- Unpublished data, Casualty Care Research Center, Department of Military and Emergency Medicine . CONTOMS Database . Bethesda, MD : Uniformed Services University of Health Sciences .
- Schwarz R , Lerner B , Llewellyn C , et al. Development of a national consensus for Tactical Emergency Medical Support (TEMS) training programs-operators and medical providers . J Spec Oper Med . 2014 ; 14 : 122 – 38 .
- Butler F , Holcomb J , Giebner SD , McSwain NE , Bagian J . Tactical combat casualty care 2007: evolving concepts and battlefield experience . Mil Med . 2007 ; 172 : 1 – 19 .
- R Farr , ed. USSOCOM Medic Certification Program . J Spec Oper Med . 2007 ; 7 .
- Kolman JA . A Guide to the Development of Special Weapons and Tactics Teams . Springfield, IL : Charles C. Thomas , 1982 .
- Rasumoff D. EMS at tactical law enforcement operations seminar a success . Tactical Edge . 1989 ; 7 : 25 – 9 .
- Carmona R , Brennan K . Tactical emergency medical support conference (TEMS): a successful joint effort . Tactical Edge . 1990 ; 8 : 7 .
- National Tactical Officers Association . Tactical Response and Operations Standard for Law Enforcement Agencies . NTOA SWAT Standard 2018 .
- Jones JS , Reese K , Kenepp G , Krohmer J . Into the fray: integration of emergency medical services and special weapons and tactics (SWAT) teams . Prehosp Disaster Med . 1996 ; 11 : 202 – 6 .
- Mabry RL , DeLorenzo R . Challenges to improving combat casualty survival on the battlefield . Mil Med . 2014 ; 179 : 477 – 82 .
- Investigation into the Activities of Federal Law Enforcement Agencies Toward the Branch Davidians . 104th Congress, 2nd Session, August 1996; Report 104–749, United States House of Representatives.
- Position Statement of the Counter Narcotics Tactical Operations Medical Support Program . In: Counter Narcotics Operational Medical Support Emergency Medical Technician—Tactical. Bethesda, MD : Uniformed Services University of the Health Sciences , 1994 .
- Callaway DW , Smith ER , Cain J , et al. Tactical Emergency Casualty Care (TECC): guidelines for the provision of prehospital trauma care in high threat environments . J Spec Oper Med . 2011 ;: 104 – 22 .
- DeFeo DR , Givens ML . Integrating chemical biological, radiologic, and nuclear (CBRN) protocols into TCCC. Introduction of a conceptual model—TCCC + CBRN = (MARCHE) . JSOM . 2018 ; 18 : 118 – 23 .
- National Association of Emergency Medical Technicians . Civilian tactical emergency medical support (TEMS) . In: Prehospital Trauma Life Support . 8th ed. Burlington, MA : Jones & Bartlett Learning , 2015 .
-
Butler FK
,
Blackbourne LH
.
Battlefield trauma care then and now: a decade of Tactical Combat Casualty Care
.
J Trauma
.
2012
;
73
(
6
):
S431
–
7
.
10.1097/TA.0b013e3182754850 Google Scholar
-
Bozeman WP
,
Stopyra JP
,
Klinger DA
, et al.
Injuries associated with police use of force
.
J Trauma
.
2018
;
84
:
466
–
472
.
10.1097/TA.0000000000001783 Google Scholar
- Schep LJ , Slaughter RJ , McBride DI . Riot control agents: the tear gases CN, CS, and OC–a medical review . J Royal Army Med Corps . 2015 ; 161 : 94 – 9 .
- Stopyra JP , Winslow JE , Johnson JC , et al. Baby shampoo to relieve the discomfort of tear gas and pepper spray exposure: a randomized controlled clinical trial . West J Emerg Med . 2018 ; 19 : 294 – 300 .
- Kester D , Ijames S . Patterns of injury, recognition, and treatment for less lethal law enforcement techniques . Top Emerg Med . 2003 ; 25 : 316 – 25 .
- Bozeman WP , Hauda II WE , Heck JJ , et al. Safety and injury profile of conducted electrical weapons used by law enforcement officers against criminal suspects . Ann Emerg Med . 2009 ; 53 : 480 – 9 .
- E-Labs, Inc . Performance characterization study of noise flash diversionary devices (NFDDs) 2004 . Retrieved July 9, 2020, from https://www.ncjrs.gov/pdffiles1/nij/grants/205642.pdf
- Winslow JE , Bozeman WP , Fortner MC , Alson RL . Thoracic compression fractures as a result of shock from a conducted energy weapon: a case report . Ann Emerg Med . 2007 ; 50 : 584 – 6 .
- Levine SD , Sloane CM , Chan TC , Dunford JV , Vilke GM . Cardiac monitoring of human subjects exposed to the TASER® . J Emerg Med . 2007 ; 33 : 113 – 7 .
- Barnes DG , Winslow JE , Alson RL , Johnson J , Bozeman WP . Cardiac effects of the TASER® conducted energy weapon . Ann Emerg Med . 2006 ; 48 : 102 .
- Ideker RE , Dosdall DJ . Can the direct cardiac effects of the electric pulses generated by the TASER® X26 cause immediate or delayed sudden cardiac arrest in normal adults? Am J Forensic Med Pathol . 2007 ; 28 : 195 – 201 .
- Kroll MW , Lakkireddy D , Rahko PS , Panescu D . Ventricular fibrillation risk estimation for conducted electrical weapons: critical convolutions . Engineering in Medicine and Biology Society (EMBC) 2011 Annual International Conference of the IEEE, Aug. 30 2011–Sept. 3 2011.
- Heegaard WG , Halperin HR , Luceri R . Letter by Heegaard et al. regarding article, “sudden cardiac arrest and death following application of shocks from a TASER® electronic control device.” Circulation . 2013 ; 127 : e260 .
- Carmona R , Prince K . Trauma and forensic medicine . J Trauma 1989 ; 29 ( 9 ): 1222 – 1225 .
- Vilke GM , Payne-James J , Karch SB . Excited delirium syndrome (ExDS): redefining an old diagnosis . J Forensic Leg Med . 2012 ; 19 : 7 – 11 .
- Mash DC . Excited delirium and sudden death: a syndromal disorder at the extreme end of the neuropsychiatric continuum . Front Physiol . 2016 ;: 435 .
- Farnham FR , Kennedy HG . Acute excited states and sudden death: much journalism, little evidence . Br Med J . 1997 ; 315 : 1107 – 1108 .
- Was it “excited delirium” or police brutality? 60 Minutes, December 9, 2003 . Available at https://www.cbsnews.com/news/excited-delirium/ . Accessed August 25, 2020.
- Death by excited delirium: diagnosis or cover-up? NPR, February 26, 2007 . Available at: http://www.npr.org/templates/story/story.php?storyId=7608386 . Accessed August 25, 2020.
- Ten training tips for handling excited delirium . Police One.com News, October 14, 2005. Available at: https://www.police1.com/archive/articles/10-training-tips-for-handling-excited-delirium-1llRYRi2Jj7ctrkJ/ . Accessed August 25, 2020.
- Ho JD , Dawes DM , Nelson RS , et al. Acidosis and catecholamine evaluation following simulated law enforcement “use of force” encounters . Acad Emerg Med . 2010 ; 17 : e60 – 8 .
- Heck JJ . Role of preventive medicine in TEMS . Top Emerg Med . 2003 ; 25 : 299 – 305 .
- Conley KM , Bolin DJ , Carek PJ , et al. National Athletic Trainers’ Association Position Statement: preparticipation physical examinations and disqualifying conditions . J Athl Train . 2014 ; 49 : 102 – 20 .
- Fisher AD , Dunn J , Pickett JR , et al. Implementation of a low titer O whole blood program for a law enforcement tactical team . Transfusion . 2020 ; 60 3 : S36 – S44 .
- Warner S. The need for standardization among TEMS providers: training, credentialing, and roles . Tactical Edge . 2013 ; Spring:90–4.
- Medical threat assessment . In: Counter Narcotics and Terrorism Operational Medical Support Manual Emergency Medical Technician-Tactical . Bethesda, MD : Uniformed Services University of Health Sciences , 2019 .
- Joyce S , Grow R , Brenneman JL , et al. EMS, Tactical Remote Assessment and Surrogate Care . Treasure Island, FL : StatPearls Publishing , 2020 .
- Mack M , Springer B , Ten-Eyck R . Medicine across the barricade . Med Ed Portal . 2013 ; 9 .
- Vayer J , Hagmann J , Llewellyn C . Refining prehospital physical assessment skills: a new teaching technique . Ann Emerg Med . 1994 ; 23 : 786 – 90 .
- Hasty decontamination . In: Counter Narcotics and Terrorism Operational Medical Support Manual Emergency Medical Technician-Tactical . Bethesda, MD : Uniformed Services University of Health Sciences , 2019 .
- Schwartz RB , McManus JG Jr , Croushorn J , et al. Tactical medicine–competency-based guidelines . Prehosp Emerg Care . 2011 ; 15 : 67 – 82 .
- Quinn M. Into the fray: The search and rescue role with special weapons teams . Response . July/August 1987 .
- Smock W , Hamm M , Krista M . Physicians in tactical emergency medicine . Ann Emerg Med . 1999 ; 34 : S73 .
- Callaway D , Smith E , Cain J , Shapiro G , Burnett W , McKay S , Mabry R . Tactical Emergency Casualty Care (TECC): guidelines for the provision of prehospital trauma care in high threat environments . J Spec Oper Med . 2011 ; 11 : 104 – 22 .
- Metzger JC , Eastman AL , Benitez FL , et al. The lifesaving potential of specialized on-scene medical support for urban tactical operations . Prehosp Emerg Care . 2009 ; 4 : 528 – 31 .
- Young JB , Sena MJ , Galante JM . Physician roles in TEMS: the first 20 years . J Emerg Med . 2014 ; 46 : 38 – 45 .
- Lavery RF , Addis MD Doran JV , et al. Taking care of the “good guys”: a trauma center–based model of medical support for tactical law enforcement . J Trauma . 2000 ; 48 : 125 – 9 .
